Job Search Status
Open to workDesired start date: Open to discussion
Desired Job Title
Claims AnalystAssistant ManagerWork Type
Full TimeLocation Preference
HybridLocation: Haltom City, TXFort Worth, TX
Open to relocation: Yes
Open To Work
Angela Fagan
Haltom City,TX
Work Preference
Summary
Results-driven Claims Analyst with a proven track record at Elevate PfFS, excelling in claims analysis and dispute resolution. Adept at leveraging critical thinking and interpersonal communication to enhance client satisfaction and streamline processes, achieving a significant reduction in claims processing time while mentoring team members for professional growth.
Work History
Claims Analyst
Elevate PfFS
- Analyzed claims data to identify patterns and trends, ensuring accuracy in processing.
- Collaborated with cross-functional teams to resolve complex claims inquiries effectively.
- Reviewed policy documentation to ensure compliance with regulatory requirements and company standards.
- Developed and maintained comprehensive claims reports for management review and decision-making support.
- Streamlined claim processing workflows, reducing turnaround times for resolution and enhancing efficiency.
- Trained new team members on claims analysis software and best practices for accurate submissions.
- Led initiatives to improve claims handling procedures, resulting in increased client satisfaction rates.
- Conducted audits of processed claims to ensure adherence to quality assurance protocols and mitigate errors.
- Maintained strict confidentiality with all personal data as per company guidelines.
- Managed high-volume caseloads, prioritizing tasks to ensure timely completion of all claims.
- Maintained compliance with industry regulations and company policies while managing sensitive client information and claims records.
- Enhanced customer satisfaction by resolving complex claims issues in a timely manner.
- Demonstrated a high level of accuracy and attention to detail in reviewing claim documentation for approval or denial decisions.
- Participated in ongoing training programs to stay current on industry developments and maintain a strong understanding of relevant laws and regulations affecting the claims process.
- Conducted thorough investigations into each claim, gathering relevant data and documentation to support decision-making processes.
- Interacted with clients and employees, which helped cultivate positive working relationships.
- Reduced claims processing time by implementing efficient analytical techniques and strategies.
- Maintained strong working relationships with third-party vendors, such as independent adjusters and appraisers, to facilitate prompt resolution of claims.
- Provided exceptional customer service by promptly addressing inquiries from policyholders, agents, and other stakeholders regarding the status of their claims.
- Continuously sought opportunities to streamline workflows and implement process improvements within the claims department, resulting in increased efficiency and productivity levels.
- Streamlined workflow processes for improved efficiency and reduced claim resolution times.
- Collaborated with cross-functional teams to develop best practices for claim handling procedures.
- Supported internal audit initiatives by providing detailed documentation of claims handling procedures as required for compliance purposes.
- Mentored junior team members, sharing expertise in claims analysis techniques and fostering professional growth within the department.
- Identified trends in claim patterns, providing actionable insights for process improvements and risk mitigation strategies.
- Negotiated successful settlements with clients, ensuring a mutually beneficial outcome for all parties involved.
- Examined claims forms and other records to determine insurance coverage.
- Conducted day-to-day administrative tasks to maintain information files and process paperwork.
Assistant Manager
Eckerd Drugs
- Assisted in managing daily operations and ensuring compliance with company policies.
- Coordinated staff schedules to optimize workforce efficiency and maintain service levels.
- Trained new employees on operational procedures, promoting adherence to best practices.
- Collaborated with management to analyze sales trends and adjust product offerings accordingly.
- Led team meetings focused on enhancing communication and boosting morale among staff members.
- Developed strong working relationships with staff, fostering a positive work environment.
- Completed regular inventory counts to verify stock levels, address discrepancies, and forecast future needs.
- Managed inventory levels to minimize stockouts while reducing overhead costs.
- Mentored junior staff members in their professional development by offering guidance/support in their assigned roles.
- Analyzed medical claims for accuracy and compliance with regulatory guidelines.
- Reviewed and resolved claim discrepancies to ensure timely payments.
Education
Associate Of Applied Science - General Studies
Tarrant County College
Fort Worth, TXHigh School Diploma -
Haltom High School
Fort WorthSkills
- Friendly, positive attitude
- Teamwork and collaboration
- Customer service
- Problem-solving
- Time management
- Attention to detail
- Flexible and adaptable
- Dependable and responsible
- Excellent communication
- Critical thinking
- Computer skills
- Organizational skills
- Calm under pressure
- Active listening
- Organization and time management
- Decision-making
- Problem resolution
- Verbal communication
Timeline
High School Diploma -
Haltom High School
Associate Of Applied Science - General Studies
Tarrant County College
Assistant Manager
Eckerd Drugs
Claims Analyst
Elevate PfFS